What's on your surgeon's playlist?

Music streaming services have changed the way doctors listen to music in the operating room.

When you're asleep in the operating room, your surgeon is most likely listening to music. But what kind of music and why?

An article in the Christmas issue of the British Medical Journal sheds light on the matter by summing up research findings and delving into types of music surgeons listen to.

For one, music in the operating room is pretty common. Some studies show that music is played up to 70 percent of the time in the operating room, and it is most often selected by the leading surgeon.

Music also appears to have benefits for everyone in the OR. In one study, many of the staff said that music helped with communication, reducing anxiety and improving efficiency. It also enhanced surgical performance by increasing focus, especially among surgeons who listened to music regularly.

Dr. Debashish Bose, a pancreatic and liver surgeon at UF Health Cancer Center - Orlando Health, said he saw surgeons play music in the OR when he was in medical school. "I picked up the habit of creating playlists for the operating room during my fellowship," he said. "And that followed me in my career as an attending. I try to make choices that are light and pleasant for everybody."

Music found its way to the operating room as far back as 100 years ago, when a Pennsylvania surgeon name Evan Kane said that it was an optimal means of "calming and distracting the patient from the horror of the situation," according to the BMJ article. Back then, he played the phonograph.

The reason doctors play music in the OR has drastically changed since then, not to mention that there are better alternatives to a phonograph

"I used to burn my own CDs and bring a boom box, those ones with a six-disc player, to the operating room," said Dr. Michael Keating, a pediatric urologic surgeon at Florida Hospital for Children. Then came the iPod, but the selection was still limited to the music you owned.

"I've been using Spotify," said Keating, who learned about the service from his daughter. "I put together playlists for rhythm and blue and soul music, and for my favorite show tunes. We have playlists of the 80s with Journey and Bad Company. And sometimes I put together a big goulash of stuff from Sinatra to Classic Jazz."

Dr. Jeffrey Feiner, a plastic and reconstructive surgeon at UF Health Cancer Center - Orlando Health said that one of the scrub techs in the operating room has a treasure trove of music and usually plays "a great mix of music." In his absence, "we use Pandora. Today, we listened to the Eye of the Tiger." And sometimes, when patients are under local anesthesia and want music, he plays the patient's choice of music, he said.

Some studies show that the most predominant music of choice for surgeons is classical music, but surgeons' taste for music is wide.

Keating said that his partner who does robotic surgery likes to listen to reggae during the operation. "There's something about the rhythm that relaxes him," he said.

Bose said he plays a mix of 70s, 80s and 90s. "I make playlists for jazz, classical music, and sometimes rock. But nothing too hard core. Just to keep the beat going."

Dr. Steven Frick of the department of surgery at Nemours Children's Hospital said he listened to country music. And Dr. Christopher Iobst of the department of orthopedics at Nemours said he listened to ABC: Anything But Country. Dr. Cynthia Chen and Dr. Julie Wei of the division of otolaryngology at Nemours said they preferred Top 40.

Dr. Steven Hoff, a cardiovascular surgeon at Orlando Health Heart Institute said being from Nashville, "we listen to both kinds of music in the OR, country and Western... of course, from Thanksgiving to New Year's we listen to country Christmas."

The authors of the BMJ study made some suggestions for song choices. They recommended Bee Gees' Stayin' Alive, Sade's Smooth Operator, Coldplay's Fix You, and Wham's Wake Me Up Before You Go-Go.

But they advised against Queen's Another One Bites the Dust, REM's Everybody Hurts, Radiohead's Knives Out, Red Hot Chili Peppers' Scar Tissue, and Hip Hop trio's House of Pain. (If you have a Spotify account, you can see BMJ's surgical playlist.)

At the end of the day, playing music in the OR is a personal choice. Critics say that it can consume cognitive bandwidth, reduce vigilance, and be a distraction. But proponents say that music is relaxing and provides the rhythm to keeps things moving.

"Some surgeons don't want music at all because they think it interferes with concentration," Bose said. "But it helps me relax - and I hope everyone else in the room. I find that when everyone is calm and relaxed things move smoothly. When it's totally quiet, it feels more tiring.

"Music engages a part of your brain that's emotional and mathematical. For me, it keeps me sharper," Bose said.

Hoff too said that music "lowers the stress level in a very stressful environment, without impacting concentration or efficiency."

There are, of course, certain periods that surgeons need total quiet, said Keating. "But there are times for levity. People enjoy it and it makes everybody happier."

The authors of the BMJ article said that they too embraced music in the operating room whenever they could.